Objectives　We investigated the participation and detection rates of cervical lesions in cervical screening non-attenders offered HPV (human papillomavirus) self-sampling with cytology triage.

Methods　From 2016 to 2018, HPV self-sampling was routinely offered as an option, along with cytology, to all non-attenders in Ebetsu City, Japan. The primary endpoints were ≥CIN2 and ≥CIN3 detection rates, and secondary endpoints were abnormal cytology rates and follow-up compliance.

Results　Overall, recall invitations were mailed to 6,116 non-attenders, with a response rate of 15.9% (cytology: 6.5%, HPV testing: 9.4%). Of the responders to undergo HPV self-sampling, 11.7% had a positive result and were referred to cytology triage. Moreover, ≥CIN2 and ≥CIN3 detection rates were 1.7% and 0.9%, respectively, in the HPV self-sampling group, and 1.0% and 0.8%, respectively, in the cytology group, showing no statistically significant differences. In those who underwent cytology triage following an HPV positive test, ≥CIN2 and ≥CIN3 detection rates were 23.8% and 11.9%, respectively, which was significantly higher than those who only underwent cytology alone.

Conclusion　HPV self-sampling followed by cytology triage is highly effective at detecting high grade disease in non-attenders. Thus, multi-municipality-based studies to standardize processes involving this method are warranted. Furthermore, HPV self-sampling could be a promising method for inviting non-attenders who have difficulty undergoing cervical screening in the COVID-19 pandemic era.

Objectives　In addition to physical independence such as ADLs, higher-level functional capacity (“instrumental self-maintenance,” “intellectual activity,” and “social role”) are necessary to lead the final stage of life as independently and for as long as possible. Accordingly, in a long-term follow-up study of the local population, we examined the association of health status (total mortality and incidence of care needs) with instrumental independence, intellectual activity, and social role.

Methods　We used participant data from the Kamogawa cohort study, which included surveyed use of health service, health status, disease prevalence, and use of long-term care insurance service for Kamogawa citizens in Chiba prefecture from 2003 to 2013. We compared the differences in lifestyle and higher-level functional capacity, by status of death and using the Long-term Care Insurance service. Higher-level functional capacity was assessed with the Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC); answer to each question, each domain score, and total score were examined.

Results　During the follow-up period to the end of March 2013, 810 deaths and 917 care needs were observed among the 6,503 people who consented to be followed up. The adjusted HR of higher-level functional capacity for all-cause mortality was “instrumental self-maintenance,” score 4 or 5 to less than 3: 2.03 (95%CI: 1.59-2.60), “intellectual activity,” score 4 to less than 3: 1.39 (95%CI: 1.09-1.77), and “social role,” score 4 to less than 3: 1.28 (95%CI: 1.03-1.59). In subgroup analyses by sex, “instrumental self-maintenance” was associated with both men and women, but “intellectual activity” and “social roles” were associated with women only. The adjusted HRs for the incidence of care needs were 1.93 (95%CI: 1.55-2.40) for “instrumental self-maintenance” and 1.30 (95%CI: 1.07-1.58) for “social role.” In subgroup analyses by sex, “instrumental self-maintenance” was associated with both genders, but “social role” was observed only for women.

Conclusion　Higher-level functional capacity (“instrumental self-maintenance,” “intellectual activity,” and “social role”) was significantly associated with total mortality and incidence of care needs.

Objectives　This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.

Methods　A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.

Results　Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3)higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.

Conclusions　In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.

Objectives　Nine years after the accident at the TEPCO Fukushima Daiichi Nuclear Power Plant in March 2011, anxiety about the effects of radiation on future generations persists. We considered the possibility that information from mass media sources and the Internet might influence this anxiety. Thus, this study examined the relationship between information sources and anxiety; based on the results, we consider the necessary measures to reduce this anxiety.

Methods　We conducted a mail-based survey by distributing an anonymous self-administered questionnaire to 2,000 Fukushima Prefecture residents aged 20 to 79. We randomly selected 500 residents from Aizu, Nakadori, Hamadori, and the evacuation areas, and compared the data obtained from Hamadori and the evacuation areas. The objective variable was anxiety about the effects (of radiation) on future generations, while the explanatory variables were trusted sources and media the respondents used to get information on radiation. Other variables assessed included health status and knowledge of radiation. We conducted univariate analysis of combined data to assess the relationship between anxiety and the questionnaire items. This was followed by multiple regression analysis with anxiety as the objective variable and those showing significant differences in the univariate analysis as the explanatory ones. We then conducted multiple regression analysis, that included the interaction means between explanatory variables and evacuation areas.

Results　Of the 500, 201 respondents were from Hamadori (40.2%) and 192 from the evacuation areas (38.4%). Multiple regression analysis revealed that anxiety was significantly lower among those who trusted government ministries and those who were healthy. Anxiety was also significantly lower among those who correctly answered the question on the genetic influence of radiation, while it was significantly higher among those who correctly answered the question on the dose-response model of radiation-induced cancer. In Hamadori, anxiety was significantly higher among those who watched private national television. In the evacuation areas, the result was the same as that of the combined data.

Conclusion　Different information sources and media were significantly associated with anxiety about the effects of radiation on future generations. Therefore, media sensationalism should be reduced to prevent anxiety among citizens. Our findings highlight the importance of selecting information sources and media that disseminate accurate information, as well as the need to improve media literacy among citizens. Furthermore, a dose-response model of radiation-induced cancer must be communicated in a way that is not misleading. Receiving accurate information on the genetic effects of radiation can reduce anxiety among citizens.